The present invention relates to a support apparatus for performing mammograms and breast biopsies during which the patient is in the decubitus position. More specifically, the present invention provides an apparatus and method for accurately repositioning a patent, maintaining the patient in the selected position for breast biopsy and preventing discomfort to the patients bottom arm and shoulder which are supporting the patient""s weight during mammography performed in the decubitus position.
Advances in the field of mammography have enabled early detection and treatment of cancerous and precancerous tissues. When a mammogram is taken, it is analyzed by a radiologist. If suspicious images are found, a biopsy of the tissue is taken. Mammography typically has been performed with the patient in the standing position, and the breast positioned between two opposed plates which flatten the tissue and hold it in place. If suspicious tissue was observed in the mammogram the physician marked the precise area to be biopsied and a tissue sample was obtained. The procedure of marking the area for biopsy involved inserting a needle into the breast, and feeding of a wire through the needle which remains in place until the biopsy is performed.
In an improved method for performing breast biopsies, known as the core biopsy technique, the patient is placed in a standing or upright sitting position and the biopsy is taken by positioning the patient""s breast between the opposed plates of a mammography device. Then, using a medical instrument known as a xe2x80x9cbreast tissue sampler,xe2x80x9d a core of tissue is cut at the position indicated by the mammogram. This procedure represents a significant advance, in that the patient is not required to remain with a wire projecting from her breast or move to a remote location for the surgical biopsy. Instead, the biopsy can be performed in the same location as the initial mammogram.
However, during the performance of the core biopsy, it is possible for the patient to move slightly, or worse to faint. Either reaction presents significant problems both for the patient and the technician or radiologist. In one instance a sample from the wrong area is taken, and in the other an incorrect sample can be taken and the patient can be injured by falling. One solution to this problem is to support the patient during core breast tissue sampling by using an examination table having a central, surrounded and not laterally accessible opening therein. With such an examination table, the patient lies in a prone position with her breasts hanging downwardly through the opening. This type of support table is known as a xe2x80x9cprone tablexe2x80x9d or xe2x80x9cParker table.xe2x80x9d The Parker table is large and not readily repositionable, making access to the breast region difficult. The Parker table also presents a problem in attempting to locate tumors when the patient is small breasted or the suspected tumor is adjacent the chest wall, i.e., the rib cage area.
Thus it would be beneficial if the patient could have mammograms, needle localizations and core biopsies performed when lying on her side. This is known as the decubitus position, wherein the patient""s breast is oriented toward the mammogramxe2x80x94preferably with the upper breast positioned for mammography or biopsy, but sometimes with the lower breast examined. The patient may thus be positioned in a left lateral decubitus (left side of patient down) or right lateral decubitus (right side of patient down) to present her breast to for examination. This may require the patient to position her head at either end of the support, or to rotate longitudinally (with feet and head remaining at the same relative ends of the bed) to present the breast in the proper position. The patient must be adequately supported and this support must be provided without giving the patient a sense of anxiety about falling off the support. Additionally, the support must permit access by the technician and access to the mammography and core biopsy machine to enable performance of the mammogram and/or biopsy procedure.
Prior art patient supports are perhaps best shown in U.S. Pat. Nos. 5,184,363 and 5,461,739 to Falbo, Sr., and 5,950,262 to Smoler et al., the disclosures of which are incorporated herein by reference. Such supports are beneficially configured with drop-out sections to permit access by the technician to the patient. However, these patient supports are not configured to meet the peculiar demands of decubitus breast mammography and biopsy. For example the U.S. Pat No. 5,184,363 patent discloses a support bed useful for cardiac sonography having two drop-out sections, the first to permit sonographic diagnosis of a patient lying on the bed, the second to accommodate the legs or other aspect of a person performing the diagnosis. However, the openings do not admit access by a mammography and core biopsy device, nor is the table particularly configured to permit alternate positioning of the patient on either the left or right side. Moreover, a mammography device often must be tilted in which case a bulky portion of the device must lie adjacent the patient""s head and below the top surface of the table, which is not possible with the aforementioned support bed. The U.S. Pat. No. 5,461,739 support apparatus is also designed for performing cardiac sonography, but with the patient in a supine position (resting on the back) and accommodating a pedaling device. It also teaches the use of one, or alternatively two, patient drop-out, sections, but is not configured to admit into the openings a mammography and core biopsy device, nor to allow the patient to rest in a variety of different positions to present the breast for examination.
A bed or examination table which allows the patient to be positioned on her side is the subject of U.S. patent application Ser. No. 09/712,475. This patent application teaches the use of an examination table or bed in which the patient may be positioned in a left lateral decubitus or right lateral decubitus position to present her breast for examination and biopsy. While the bed or table of U.S. patent application Ser. No. 09/712,475 provides substantial benefits to the patient, additional improvements and embodiments of the examination table or bed have been discovered which can further increase patient comfort while in the decubitus position, and which can increase the accuracy of the biopsy procedure.
It will be appreciated by those skilled in the art that while a patient is in the decubitus position (FIG. 1) that the patient is able to roll forward and backward on the examination table. Such a forward or backward rolling movement could remove the area of the breast to be biopsied from the field of the biopsy needle. Further, it will be appreciated that the entry of a biopsy needle into the breast and the withdrawal of the needle is a procedure offering discomfort to the patient. This discomfort and the anticipation of it can cause a patient to shift position and even slightly pull away from the biopsy device. This can result in inaccurate biopsy procedures and the need to reperform the unpleasant procedure. Therefore a means for bracing the patient and reducing patient movement while in the decubitus position would greatly benefit the biopsy procedure.
An additional embodiment of the examination table or bed of U.S. patent application Ser. No. 09/712,475 is provided in the present application and which reduces or eliminates the discomfort caused to a patient from being positioned in the left lateral decubitus or right lateral decubitus position for a period of time. While in the left lateral decubitus or right lateral decubitus position much of the patient""s weight is resting on the patient""s downward arm and shoulder. If the patient is required to remain in the lateral decubitus position for a time the patient can experience pain or the local loss of feeling in the arm or shoulder which is in contact with the examination table. Therefore, a means for reducing the pressure of the patient""s body weight on the patient""s downward arm and shoulder would be beneficial.
A further problem associated with positioning a patient in either the left lateral decubitus or right lateral decubitus position occurs when a removable filler panel as described in U.S. patent application Ser. No. 09/712,475 is removed and the patient attempts to allow their arm to drop below the surface of the table. In this instance the patient""s arm is simply left to dangle downwardly and can contribute to the patient feeling unstable and can contribute to a tendency for the patient to roll forward into the mammography or biopsy device. Therefore, it would be beneficial if an examination table which allows the patient to be positioned in the left or right lateral decubitus positions were to provide a stabilizing means for the patent while the patient""s arm is hanging below the table surface.
Yet another advantage could be obtained for the radiologist or technologist using the device of U.S. patent application Ser. No. 09/712,475 if a limited degree of movement of the patent""s breast in the lateral planexe2x80x94a plane parallel to the surface of the bed or tablexe2x80x94could be achieved. In a biopsy procedure it may be necessary to take a biopsy from more than one location in a breast, or it may be necessary to shift a patient to place the area to be biopsied more centrally under the biopsy needle. In these cases, presently, the radiologist or technologist must either adjust the position of the patient by directing the patient to move their body slightly, or by readjusting the breast within the biopsy device, or by repositioning the biopsy device. These options do not provide the radiologist or technologist with the fine degree of control which would be beneficial in achieving biopsy accuracy. Therefore it would be of great benefit to a radiologist or technologist if a means were available which would allow the repositioning of a patient, or patients breast with respect to a breast biopsy device.
A further problem is associated with examination tables which position a patient in the left or right lateral decubitus position. If the patient is short in stature, the patient""s head will not extend to the end of the table where it can be supported at a different level of height from the table surface. In such cases the patient cannot be shifted toward the headrest as then the patient would not be aligned with the filler section openings. Therefore, it would be beneficial if a headrest for use with left or right lateral decubitus position breast biopsy examination tables were known which would allow the head of a short patient to be supported at a level above the height of the examination table surface.
These needs have largely been achieved by the method and apparatus of the present invention which in one embodiment provides a method and apparatus of bracing the patient to prevent forward and rearward movement of the patient with respect to a core biopsy device and which in another embodiment provides a method and apparatus for reducing the pressure placed on the downward arm and shoulder of a patient while in the decubitus position and which in another embodiment provides a method and apparatus for adjusting the position of a patient and/or the patient""s breast, while the patient is in the decubitus position.
The method and apparatus of bracing the patient to prevent forward and rearward movement of the patient with respect to a core biopsy device comprises the bracing of a patient""s rear shoulder area by positioning of a pad against the patient""s upper back and shoulder area to prevent rearward movement and to provide a reference point for the patient to press against to assist in preventing forward rolling movement of the patient.
The method and apparatus for reducing the pressure placed on the downward arm and shoulder of a patient while in the decubitus position comprises the provision of a recess or depression in the examination bed or table adjacent the location of the patient""s shoulder on the examination table. This recess or depression allows the patient to extend the arm downwardly and to shift the patient""s body weight from the downward arm and shoulder and onto the patient""s chest wall area.
The method and apparatus for providing a stabilizing means for the patient while the patient""s arm is hanging below the table surface comprises a patient support which can be grasped by the patient""s downwardly hanging arms and which allows the patient to hold themselves in position and prevent forward rotation of their body toward the biopsy or mammography apparatus while providing the patient with a sense of security and control over their body position.
The method and apparatus for adjusting the position of a patient and/or the patient""s breast, while the patient is in the decubitus position comprises the mounting of the table frame on a system of dual, laterally shifting support surfaces which are independently moveable with respect to one another. The surfaces are positioned between the table frame and the upright support and, when released either separately or together, allow a user to shift the table and a patient thereon in two degrees of movement. The two degrees of movement allow movement in all direction in a plane which is parallel to the surface of the examination table. Once the patient is properly repositioned the table surface can be locked into position for the procedure.
The method and apparatus for supporting the shorter patient""s head comprises a frame for use with a head support, the frame allowing the head support cushion to be shifted along the longitudinal axis of the examination table to allow the head support to be moved inwardly of the examination table frame to allow positioning of the head support under the head of the shorter stature patient.